Anafilaxia. Manejo práctico de autoinyectores de adrenalina

17 páginas.Capítulo incluido en el libro: Actualización en alergología para médicos de atención primaria. Manuel Alcántara Villar (Coordinador). Sevilla: Universidad Internacional de Andalucía, 2018. ISBN 978-84-7993-340-1. Enlace: http://hdl.handle.net/10334/3910

Inclusive language and gender perspective in advertising

En el diseño de estrategias creativas que ayude a las compañías a erigirse como marcas útiles o con propósito, uno de los aspectos clave hoy en día es el relacionado con la igualdad de género, expresada tanto a través de la presencia en las historias publicitarias de situaciones igualitarias que rompan con estereotipos de género como mediante el uso de fórmulas de lenguaje inclusivo. El principal objetivo del estudio es analizar los elementos de lenguaje inclusivo y de perspectiva de género presentes en las campañas publicitarias, a partir de una muestra de 66 acciones premiadas en la edición de 2022 de El Sol, Festival Iberoamericano de la Comunicación Publicitaria. Los resultados evidencian que las acciones en las que se tiene en cuenta el lenguaje inclusivo son minoritarias, que entre las campañas premiadas existen acciones con presencia de situaciones de tipo patriarcal, con exposición de cuerpos normativos y con cosificación de la mujer y que son los anunciantes los que publican, con más frecuencia que las agencias, compromisos en este sentido, especialmente en sus programas de Responsabilidad Social Corporativa. Si bien las empresas están asumiendo un papel más activo incorporando en sus políticas cuestiones de inclusión y diversidad, es importante el diseño de un discurso responsable, especialmente en las estrategias de comunicación persuasiva, que fomente la igualdad y en el que se emplee un lenguaje inclusivo.In the design of creative strategies that help companies to establish themselves as useful or purposeful brands, one of the key aspects today is related to gender equality, expressed both through the presence in advertising stories of egalitarian situations that break with gender stereotypes and through the use of inclusive language formulas. The main objective of the study is to analyze the elements of inclusive language and gender perspective present in advertising campaigns, based on a sample of 66 actions awarded in the 2022 edition of El Sol, Ibero-American Festival of Advertising Communication. The results show that the actions in which inclusive language is taken into account are a minority, that among the winning campaigns there are actions with presence of patriarchal situations, with exposure of normative bodies and with objectification of women and that it is advertisers who publish, more frequently than agencies, commitments in this regard, especially in its Corporate Social Responsibility programs. While companies are taking a more active role by incorporating inclusion and diversity issues into their policies, it is important to design a responsible discourse, especially in persuasive communication strategies, that promotes equality and in which inclusive language is used

Resensitization in suspected penicillin allergy

Background The diagnosis of allergic reactions to penicillins (AR-PEN) is very complex as there is a loss of sensitization over time, which leads to negative skin tests (STs) and specific IgE in serum, and even to tolerance to the drug involved. However, STs may become positive after subsequent exposure to the culprit drug (resensitization), with the risk of inducing potentially severe reactions. The exact rate of resensitization to penicillins is unknown, ranging from 0% to 27.9% in published studies. Objectives To analyze the rate of resensitization in patients with suggestive AR-PEN by repeating STs (retest) after an initial evaluation (IE). Material and Methods Patients with suspected AR-PEN were prospectively evaluated between 2017 and 2020. They underwent STs, and a randomized group also underwent a drug provocation test (DPT) with the culprit. Only patients with negative STs and/or DPT were included. All included cases were retested by STs at 2–8 weeks. Results A total of 545 patients were included: 296 reporting immediate reactions (IRs) and 249 non-immediate reactions (NIRs). Eighty (14.7%) cases had positive results in retest (RT+): 63 (21.3%) IRs and 17 (6.8%) NIRs (p < 0.0001). The rate of RT+ was higher in anaphylaxis compared with all other reactions (45.8% vs 9.1%, p < 0.0001). The risk of RT+ was higher from the fifth week after IE (OR: 4.64, CI: 2.1–11.6; p < 0.001) and increased with the patient's age (OR: 1.02; CI: 1.01–1.04; p = 0.009). Conclusions Due to the high rate of resensitization, retest should be included in the diagnostic algorithm of IRs to penicillins after an initial negative study, especially in anaphylaxis, to avoid potentially severe reactions after subsequent prescriptions of these drugs.he present study has been supported by Institute of Health “Carlos III” of the Ministry of Economy and Competitiveness (grants cofunded by European Regional Development Fund (ERDF): PI18/00095, RETIC ARADYAL RD16/0006/0001). Andalusian Regional Ministry of Economy and Knowledge (grants cofunded by European Regional Development Fund (ERDF): CTS-06603); Andalusian Regional Ministry Health (grants PI-0241-2016 and PE-0172-2018). GB holds a “Juan Rodes” (JR18/00054), Institute of Health “Carlos III” of the Ministry of Economy and Competitiveness (grants cofunded by European Social Fund [ESF]). ID is a Clinical Investigator (B-0001-2017), Andalusian Regional Ministry Health

The value of the basophil activation test in the evaluation of patients reporting allergic reactions to the BNT162b2 mRNA COVID-19 vaccine

The present study has been supported by the Institute of Health ‘Carlos III’ (ISCIII) of the Ministry of Economy and Competitiveness (grants co-funded by European Regional Development Fund (ERDF): PI18/00095, RETICS ARADYAL RD16/0006/0001; Andalusian Regional Ministry Health (PE-0172- 2018). ML is supported by the ‘Río Hortega’ program [CM20/00210] from the ISCIII. CM holds a ‘Nicolas Monardes’ research contract (RC- 0004- 2021) and ID holds an SAS Stabilization contract (ref B-0001- 2017) by Andalusian Regional Ministry Health. Funding for open access charge: Universidad de Málaga / CBU

Diagnosis of immediate reactions to amoxicillin: Comparison of basophil activation markers CD63 and CD203c in a prospective study

Amoxicillin (AX) combined or not with clavulanic acid (CLV) is frequently involved in IgE-mediated reactions. Drug provocation test (DPT) is considered as the gold standard for diagnosis, although contraindicated in high-risk patients. Basophil activation test (BAT) can help diagnose immediate reactions to beta-lactams, although controversy exists regarding the best activation marker. We have performed a real-life study in a prospective cohort to analyze the real value of BAT as diagnostic tool and the best activation marker, CD63 and CD203c, for the evaluation of immediate reactions to these drugs.We thank Claudia Corazza for her invaluable English language support; Verónica Prados and Ana Molina for their help in technical support in flow cytometry methods. This work has been supported by Institute of Health “Carlos III” (ISCIII) of the Ministry of Economy and Competitiveness (MINECO; grants co-funded by European Regional Development Fund: PI15/01206, PI17/01237, PI18/00095, PI20/01734, RETICS ARADYAL RD16/0006/0001, and RICORS REI (RD21/0002/0008); Andalusian Regional Ministry of Health (grants PI-0241-2016, PE-0172-2018, and PI-0127-2020); Spanish Ministerio de Ciencia e Innovación Proyectos de I + D + I «Programación Conjunta Internacional», EuroNanoMed 2019 (PCI2019-111825-2)). AA holds a Senior Postdoctoral Contract (RH-0099-2020) with the Andalusian Regional Ministry of Health (cofunded by European Social Fund (ESF): "Andalucía se mueve con Europa". GB holds a “Juan Rodes” contract (JR18/00054) by ISCIII of MINECO (cofounded by ESF). ID holds a clinical research stabilization contract by Andalusian Regional Ministry of Health (RB-0001-2022). ML holds a “Rio Hortega” contract (CM20/00210) by ISCIII of MINECO (cofounded by ESF). CF holds a Marie Skłodowska-Curie Individual Fellowship by the European Union's Horizon 2020 research and innovation program (agreement n° PI-0241-2016101027955). CM holds a “Nicolas Monardes” research contract by Andalusian Regional Ministry of Health (RC-0004-2021). // Funding for open access charge: Universidad de Málaga / CBUA

Detection of Serum-Specific IgE by Fluoro-Enzyme Immunoassay for Diagnosing Type I Hypersensitivity Reactions to Penicillins

Diagnosis of type I hypersensitivity reactions (IgE-mediated reactions) to penicillins is based on clinical history, skin tests (STs), and drug provocation tests (DPTs). Among in vitro complementary tests, the fluoro-enzyme immunoassay (FEIA) ImmunoCAP® (Thermo-Fisher, Waltham, MA, USA) is the most widely used commercial method for detecting drug-specific IgE (sIgE). In this study, we aimed to analyze the utility of ImmunoCAP® for detecting sIgE to penicillin G (PG) and amoxicillin (AX) in patients with confirmed penicillin allergy. The study includes 139 and 250 patients evaluated in Spain and Italy, respectively. All had experienced type I hypersensitivity reactions to penicillins confirmed by positive STs. Additionally, selective or cross-reactive reactions were confirmed by DPTs in a subgroup of patients for further analysis. Positive ImmunoCAP® results were 39.6% for PG and/or AX in Spanish subjects and 52.4% in Italian subjects. When only PG or AX sIgE where analyzed, the percentages were 15.1% and 30.4%, respectively, in Spanish patients; and 38.9% and 46% in Italian ones. The analysis of positive STs showed a statistically significant higher percentage of positive STs to PG determinants in Italian patients. False-positive results to PG (16%) were detected in selective AX patients with confirmed PG tolerance. Low and variable sensitivity values observed in a well-defined population with confirmed allergy diagnosis, as well as false-positive results to PG, suggest that ImmunoCAP® is a diagnostic tool with relevant limitations in the evaluation of subjects with type I hypersensitivity reactions to penicillinsThis research was funded by the Institute of Health ‘Carlos III’ (ISCIII) of the Ministry of Economy and Competitiveness (MINECO) (grants cofunded by European Regional Development Fund: PI15/01206, PI17/01237, PI18/00095, RETICS ARADYAL RD16/0006/0001). Andalusian Regional Ministry of Health (grants PE-0172-2018, PI-0127-2020). DrNanoDall project by ISCIII thorough AES 2019 within the ERANET-EuroNanoMed-III framework (AC19/00082). AA holds a Senior Postdoctoral Contract (RH-0099-2020) with the Andalusian Regional Ministry of Health (cofunded by European Social Fund (ESF): “Andalucía se mueve con Europa”). ML holds a “Rio Hortega” contract (CM20/00210), GB and N.P.-S. hold a “Juan Rodés” (JR18/00054 and JR21/00024, respectively) with ISCIII of MINECO (cofunded by ESF). CM holds a ‘Nicolas Monardes’ research contract with the Andalusian Regional Ministry Health (RC-0004-2021). Partial funding for open access charge: Universidad de Málag

Synthetic antigenic determinants of clavulanic acid induce dendritic cell maturation and specific T cell proliferation in patients with immediate hypersensitivity reactions

Background Immediate drug hypersensitivity reactions (IDHRs) to clavulanic acid (CLV) have increased in the last decades due to a higher consumption alongside amoxicillin (AX). Due to its chemical instability, diagnostic procedures to evaluate IDHRs to CLV are difficult, and current in vitro assays do not have an optimal sensitivity. The inclusion of the specific metabolites after CLV degradation, which are efficiently recognised by the immune system, could help to improve sensitivity of in vitro tests. Methods Recognition by dendritic cells (DCs) of CLV and the synthetic analogues of two of its hypothesised antigenic determinants (ADs) was evaluated by flow cytometry in 27 allergic patients (AP) and healthy controls (HC). Their ability to trigger the proliferation of T cells was also analysed by flow cytometry. Results The inclusion of synthetic analogues of CLV ADs, significantly increased the expression of maturation markers on DCs from AP compared to HC. A different recognition pattern could be observed with each AD, and, therefore, the inclusion of both ADs achieves an improved sensitivity. The addition of synthetic ADs analogues increased the proliferative response of CD4+Th2 compared to the addition of native CLV. The combination of results from both ADs increased the sensitivity of proliferative assays from 19% to 65% with a specificity higher than 90%. Conclusions Synthetic ADs from CLV are efficiently recognised by DCs with ability to activate CD4+Th2 cells from AP. The combination of analogues from both ADs, significantly increased the sensitivity of DC maturation and T-cell proliferation compared to native CLV.This work has been supported by Institute of Health ‘Carlos III’ (ISCIII) of the Ministry of Economy and Competitiveness (MINECO) (grants co-funded by European Regional Development Fund: PI15/01206, PI17/01237, PI18/00095, PI20/01734, RETICS ARADYAL RD16/0006/0001); Andalusian Regional Ministry of Health (grants PI-0241-2016, PE-0172-2018, PI-0127-2020); Spanish Ministerio de Ciencia e Innovación (Proyectos de I+D+I «Programación Conjunta Internacional», EuroNanoMed 2019 (PCI2019-111825-2), Ministerio de Ciencia y Educación (PID2019-104293GB-I00), Instituto de Salud Carlos III (ISCIII) of MINECO (RD16/0006/0012), Junta de Andalucía ( PY20_00384 ). AA and NPS hold Senior Postdoctoral Contracts (RH-0099-2020 and RH-0085-2020) from Andalusian Regional Ministry of Health (cofunded by European Social Fund (ESF): ‘Andalucía se mueve con Europa’). JLP holds a Sara Borrell fellowship (CD19/00250) by ISCIII of MINECO (cofunded by ESF, “El FSE invierte en futuro”). GB holds a ‘Juan Rodes’ contract (JR18/00054) by ISCIII of MINECO (cofunded by ESF). MIM holds a ‘Miguel Servet II’ grant (CPII20/00028) by ISCIII of MINECO (cofunded by ESF). ML holds a ‘Rio Hortega’ contract (CM20/00210) by ISCIII of MINECO (cofunded by ESF). CM holds a ‘Nicolas Monardes’ research contract by Andalusian Regional Ministry Health (RC-0004-2021). NMR experiments for characterizing molecule structures have been performed in the ICTS ‘NANBIOSIS’, by the U28 Unit at the Andalusian Centre for Nanomedicine and Biotechnology (BIONAND). Funding for open access charge: Universidad de Málag

Differential presentation of hypersensitivity reactions to carboplatin and oxaliplatin: Phenotypes, endotypes, and management with desensitization

Background: Drug hypersensitivity reactions (DHRs) to platinum-based drugs are heterogenous and restrict their access, and drug desensitization (DD) has provided a ground-breaking procedure for their re-introduction, although the response is heterogeneous. We aimed to identify the phenotypes, endotypes, and biomarkers of reactions to carboplatin and oxaliplatin and their response to DD. Methods: Seventy-nine patients presenting with DHRs to oxaliplatin (N = 46) and carboplatin (N = 33) were evaluated at the Allergy Departments of two tertiary care hospitals in Spain. Patient symptoms, skin testing, biomarkers, and outcomes of 267 DDs were retrospectively analyzed. Results: Oxaliplatin-reactive patients presented with type I (74%), cytokine release reaction (CRR) (11%), and mixed (Mx) (15%) phenotypes. In contrast, carboplatin reactive patients presented with predominantly type I (85%) and Mx (15%) but no CRRs. Out of 267 DDs, breakthrough reactions (BTRs) to oxaliplatin occurred twice as frequently as carboplatin (32% vs. 15%; p < .05). Phenotype switching from type I to another phenotype was observed in 46% of oxaliplatin DDs compared to 21% of carboplatin DDs. Tryptase was elevated in type I and Mx reactions, and IL-6 in CRR and Mx, indicating different mechanisms and endotypes. Conclusion: Carboplatin and oxaliplatin induced three different types of reactions with defined phenotypes and endotypes amendable to DD. Although most of the initial reactions for both were type I, oxaliplatin presented with unique CRR reactions. During DD, carboplatin reactive patients presented mostly type I BTR, while oxaliplatin-reactive patients frequently switched from type I to CRR, providing a critical difference and the need for personalized DD protocols

ATM/ATR kinases link the synaptonemal complex and DNA double-strand break repair pathway choice

DNA double-strand breaks (DSBs) are deleterious lesions, which must be repaired precisely to maintain genomic stability. During meiosis, programmed DSBs are repaired via homologous recombination (HR) while repair using the nonhomologous end joining (NHEJ) pathway is inhibited, thereby ensuring crossover formation and accurate chromosome segregation.1,2 How DSB repair pathway choice is implemented during meiosis is unknown. In C. elegans, meiotic DSB repair takes place in the context of the fully formed, highly dynamic zipper-like structure present between homologous chromosomes called the synaptonemal complex (SC).3,4,5,6,7,8,9 The SC consists of a pair of lateral elements bridged by a central region composed of the SYP proteins in C. elegans. How the structural components of the SC are regulated to maintain the architectural integrity of the assembled SC around DSB repair sites remained unclear. Here, we show that SYP-4, a central region component of the SC, is phosphorylated at Serine 447 in a manner dependent on DSBs and the ATM/ATR DNA damage response kinases. We show that this SYP-4 phosphorylation is critical for preserving the SC structure following exogenous (γ-IR-induced) DSB formation and for promoting normal DSB repair progression and crossover patterning following SPO-11-dependent and exogenous DSBs. We propose a model in which ATM/ATR-dependent phosphorylation of SYP-4 at the S447 site plays important roles both in maintaining the architectural integrity of the SC following DSB formation and in warding off repair via the NHEJ repair pathway, thereby preventing aneuploidy.This work was supported by CIHR grant 119468 to M.Z., a MRC core-funded grant to E.M.-P., and National Institutes of Health grant R01GM072551 to M.P.C.Peer reviewe

El desafío de la paz: Colombia, Guatemala, Ucrania y El Salvador a la luz de los Objetivos de Desarrollo Sostenible

Recoge las ponencias expuestas por treinta y una personalidades académicas y políticas de talla internacional además de las intervenciones de las autoridades académicas de la Universidad Carlos III de Madrid y del Ministerio de Derechos Sociales y Agenda 2030, presentadas en cuatro seminarios, que comenzaron con los relativos a los procesos de paz en Colombia y Guatemala, a fines de 2021, que continuaron el 30 de marzo de 2022 con la jornada dedicada a las herramientas para buscar una solución diplomática a la guerra en Ucrania (solo un mes después de la invasión rusa) y en junio del mismo año con el relativo a los acuerdos de 1992 en El Salvador. Dichos seminarios fueron: "Los Acuerdos de Paz en Colombia, cinco años después". (Madrid, 29 y 30 de noviembre de 2021); "Los Acuerdos de Paz en Guatemala, veinticinco años después". (Madrid, 13 de diciembre de 2021); "Ucrania: Solución negociada, seguridad compartida". (Madrid, 30 de marzo de 2022); "Los Acuerdos de Paz de El Salvador, treinta años después, en el marco de la Agenda 2030". (Madrid, 22 de junio de 2022)Presentación / Juan Daniel Oliva, Carlos R. Fernández Liesa (pp.12-14). -- Prólogo / Lilith Verstrynge Revuelta, (pp. 15-16). -- Primera parte: Los acuerdos de paz en Colombia, cinco años después (p. 18). -- Apertura / Juan Romo Uroz (pp. 18-20). -- [Apertura] / Ione Belarra (pp. 20-23). -- Hacer la paz es más difícil que hacer la guerra / Juan Manuel Santos Calderón (pp. 23-27). -- No hay un acuerdo de paz que tenga un calado de reformas como el colombiano / Josefina Echavarría Álvarez (pp. 28-34). -- Juramos que nuestra única arma sería la palabra / Rodrigo Londoño Echeverri (pp. 34-38). -- Tuvisteis que hacer frente a una coyuntura política dificilísima / José Luis Rodríguez Zapatero (pp. 38-42). -- Segunda mesa: Balance, implementación y Agenda 2030 / Enrique Santiago (pp. 43-46). -- Solicito la apertura del macrocaso de la responsabilidad del Estado / Álvaro Leyva Durán (pp. 47-53). -- En Colombia existen más de cien mil desaparecidos / Luz Marina Monzón Cifuentes (pp. 54-61). -- No hay contradicción entre la búsqueda de la paz y la de la justicia / Yesid Reyes Alvarado (pp. 62-67). -- Logramos el primer acuerdo de paz con enfoque de género / Gloria Inés Ramírez (pp. 68-74). -- Segunda parte. Los Acuerdos de Paz en Guatemala, veinticinco años después (p. 75). -- Apertura / J. Daniel Oliva Martínez (pp. 75-76) , Enrique Santiago Romero (pp. 77-78). -- Guatemala es hoy un Estado capturado por mafias / José Manuel Martín Medem (pp. 78-81). -- Se firmó la paz, pero falta la construcción de una cultura de paz / Olinda Salguero (pp. 81-85). -- Guatemala se halla en el peor escenario en materia de derechos humanos desde 1986 / Velia Muralles (pp. 85-90). -- Las comisiones de la verdad registraron unas doscientas mil personas desaparecidas y ejecutadas / Erik de León (pp. 90-94). -- El problema fundamental era y es la marginación de los grupos indígenas y la pobreza extrema / Vinicio Cerezo Arévalo (pp. 94-102). -- Guatemala está peor que cuando firmamos la paz / Pablo Monsanto (pp. 103-109). -- Guatemala es un barril de pólvora con la mecha prendida / Ana Isabel Prera (pp. 109-115). -- Clausura / Ione Belarra (pp. 115-120). -- Tercera parte. Ucrania: Solución negociada, seguridad compartida (p. 121). Apertura / María Luisa González Cuéllar Serrano, Ione Belarra (pp. 122-125). -- Debemos trabajar para exponer las amenazas de esta guerra. Es necesario para sobrevivir / Noam Chomsky (pp. 125-132). -- Primera Mesa - La negociación como herramienta de resolución de conflictos / Santiago Jiménez Martín (p. 133). -- Trabajar por la paz acarrea incomprensiones y entraña riesgos / Yago Pico de Coaña (pp. 134-139). -- La Unión Europea debe volver a un papel de potencia pacífica / Gianni Labella (pp. 140-145). -- Las armas no nos salvarán / Carmen Magallón Portoles (pp. 145-149). -- Segunda mesa: Construcción de paz y seguridad compartida en Europa / Cástor Díaz Barrado (pp. 149-150). -- Un mundo sin armas nucleares es necesario y posible / Carlos Umaña (pp. 151-154). -- Pedimos una solución diplomática negociada / Mariela Kohon (pp. 155-159). -- Hay que avanzar hacia una arquitectura de seguridad europea basada en la seguridad compartida / Vicenç Fisas Armengol (pp. 159-162). -- Que la guerra en Ucrania no nos lleve a olvidar los otros conflictos armados, que también requieren nuestro apoyo / Mabel González Bustelo (pp. 163-168). -- Clausura / Carlos Fernández Liesa, Enrique Santiago (pp. 168-173). -- Cuarta parte. Los Acuerdos de Paz de El Salvador, treinta años después, en el marco de la Agenda 2030 (p. 174). -- Apertura / Montserrat Huguet Santos, Enrique Santiago (pp. 175-178). -- Hicimos la paz a través del diálogo político en medio de la guerra / Óscar Santamaría (pp. 178-182). -- Agradecemos el acompañamiento y la solidaridad de la comunidad internacional / Nidia Díaz (pp. 183-190). -- El proceso de paz no fue una confrontación ideológica / Álvaro de Soto (pp. 190-196). -- Fue el momento más importante desde la independencia nacional / Rubén Zamora (pp. 196-201). -- Segunda mesa: Los Acuerdos de Paz treinta años después: Balance, implementación y Agenda 2030 / Daniel Oliva (pp. 202-203). -- El presidente Bukele se burla de los acuerdos de paz / David Morales (pp. 203-209). -- Están en riesgo los derechos conquistados por las mujeres / Lorena Peña (pp. 209-212). -- Necesitamos una alianza en defensa de los derechos humanos / José María Tojeira (pp. 213-216). -- Tenemos que construir la unidad opositora para desplazar a esta dictadura de nuevo tipo / Maricela Ramírez (pp. 217-222). -- Clausura / Matilde Sánchez, Ione Belarra (pp. 222-224). -- Epílogo / Federico Mayor Zaragoza (pp. 225-228)